Report cites improperly filed Medicaid claims

An audit of Maryland’s Medicaid program has concluded that the state Department of Health and Mental Hygiene should refund the federal government $10.9 million in improper claims.

The inspector general’s office of the U.S. Department of Health and Human Services reviewed a random sample of 100 claims for certain personal care services meant to help Medicaid patients avoid institutionalization.

Of those, 20 claims had errors that kept them from complying with federal and state regulations, such as the use of an unqualified nursing aide or providing unauthorized services, according to the audit. Based on that sample, auditors estimate that the federal government reimbursed DHMH for about $10.9 million in costs that should not have been allowed.

Auditors also recommended that DHMH work with the state Department of Aging, which administered the waiver program, to improve control over personal care claims.

State officials plan to return the money to the federal government by June 30, the end of the fiscal year, said Chuck Milligan, deputy secretary for health care financing at DHMH. Futhermore, DHMH, rather than the Department of Aging, will administer the waiver program starting next year because of a policy change unrelated to the audit, Milligan said.

“By all evidence, the care was administered and services were rendered,” he said, explaining that the problems uncovered were errors related to documentation, rather than false or fraudulent claims.

The federal audit covered a two-year period from July 2008 to June 2010, during which Maryland’s health department claimed $67.2 million in personal care and nurse monitoring services under the waiver program.